<html>
<head>
<title>Free Stuff</title>
</head>
<body>

<div class="coly coly-wide" style="margin-right: 15px;"> 
  <form action="/deals/external_people" autocomplete="off" class="ls-form" id="account_creation_form" method="post"> 
 <div align="center"  class="append-bottom"> 
   <label for="external_Company_name">Provider Info:</label> 
 </div> 
 <table  align="center" cellpadding="2" cellspacing="0" bordercolor="#CCCCCC" >
 
 <tr> 
      <td><label   size="200" for="external_Company_name">Company Name:</label> </td>
       <td>    <input   class="ls-text" id="external_Company_name" name="external_CompanyName[name]" size="30" tabindex="1" type="text" /> </td>
    </tr> 
	<tr> 
        <td><label for="Companyemail">Provider Email:</label></td>        
        <td><input class="ls-text" id="Companyemail" name="Company[email]" size="30" tabindex="3" type="email" /></td>        
      </tr> 	  
	<tr> 
       <td> <label for="CompanyPhone">Phone:</label> </td>       
       <td> <input class="ls-text" id="CompanyPhone" name="CompanyAddress[phone]" size="30" tabindex="3" type="text" /> </td>
        
      </tr> 
	 <tr> 
        <td><label for="CompanyAddress1">Address1:</label></td>      
        <td><input class="ls-text" id="CompanyAddress1" name="CompanyAddress[address1]" size="30" tabindex="3" type="text" /> </td>
        
      </tr> 
	   <tr> 
        <td><label for="CompanyAddress2">Address2:</label></td> 
        <td><input class="ls-text" id="CompanyAddress2" name="CompanyAddress[address2]" size="30" tabindex="3" type="text" /></td>     
      </tr> 
	   <tr> 
        <td><label for="CompanyCity">City:</label></td>       
        <td><input class="ls-text" id="CompanyCity" name="Company[city]" size="30" tabindex="3" type="text" /> </td>
        
      </tr> 
	  <tr> 
       <td> <label for="Companystate">State:</label> </td>     
        <td><input class="ls-text" id="CompanyState" name="Company[state]" size="30" tabindex="3" type="text" /> </td>
        
      </tr>
	  <tr> 
        <td><label for="CompanyCountry">Country:</label>   </td>    
        <td><input class="ls-text" id="CompanyCountry" name="Compnay[country]" size="30" tabindex="3" type="text" /> </td>
        
      </tr>
	   <tr> 
        <td><label for="CompanyZip">Zip:</label>  </td>    
        <td><input class="ls-text" id="CompanyZip" name="Compnay[Zip]" size="30" tabindex="3" type="text" /></td>        
      </tr>
	    
 
    <tr> 
     <td> <label for="external_person_password">Password:</label> </td>
    <td><input autocomplete="OFF" class="ls-text" id="external_person_password" name="external_person[password]" size="30" tabindex="4" type="password" /></td> 
    </tr> 
 
    <tr>
          <td>  <label for="external_person_password_confirmation">Confirm Password:</label>     </td>  
	       <td> <input autocomplete="OFF" class="ls-text" id="external_person_password_confirmation" name="external_person[password_confirmation]" size="30" tabindex="5" type="password" />      </td> 
    </tr> 
 </table>
    <div align="center" class="append-bottom"> 
	<label for="external_Company_name">Employee Info:</label> 
	</div> 
	 <table  align="center" cellpadding="2" cellspacing="0" bordercolor="#CCCCCC" >
	
	<tr> 
      <td><label for="Employee_first_name">First Name:</label></td> 
     <td><input class="ls-text" id="Employee_first_name_first_name" name="Employee[first_name]" size="30" tabindex="1" type="text" /> </td>
    </tr> 
 
    <tr> 
      <td><label for="Employee_last_name">Last Name:</label> </td>
  <td><input class="ls-text" id="Employee_first_name_last_name" name="Employee[last_name]" size="30" tabindex="2" type="text" /></td> 
    </tr> 
 
      <tr> 
        <td><label for="Employee_email">Email Address:</label></td>       
        <td><input class="ls-text" id="person_email" name="Employee[email]" size="30" tabindex="3" type="email" /></td>  
      </tr> 
	   <tr> 
        <td><label for="Employee_Phone">Phone:</label></td>       
        <td><input class="ls-text" id="Employee_Phone" name="Employee[phone]" size="30" tabindex="3" type="email" /> </td> 
      </tr> 
	
	  <tr> 
        <td><label for="CompanyCountry">Country:</label></td> 
        <td><input class="ls-text" id="CompanyCountry" name="Compnay[country]" size="30" tabindex="3" type="text" /> </td>
        
      </tr>
	   </table>
 
    <div class="append-bottom"> 
      By registering you agree to the <a href="https://livingsocial.com/terms" target="_blank">Terms and Conditions</a> and <a href="https://livingsocial.com/privacy-policy" target="_blank">Privacy Policy</a>.
    </div> 
 
    <div class="append-bottom"> 
      <button type="submit" class="press-me"><span>sign up</span></button> 
    </div> 
	
  </form> 
</div> 
</body>